Medial and Lateral Knee Pain, Pelvic Instability and Glute Inhibition – Acute Cause vs Root Cause

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Knee pain – whether lateral knee pain, medial knee pain and even pain under the kneecap – can all be traced back to hip and pelvic instability; and often, when there’s pelvic instability or one hip has become destabilized, the gluteus medius gets involved to stabilize. 

What does all this mean? Let’s break it down:

Lateral knee pain is often a result of knotted up (dense/restricted/adhesed) fascia in the outer part of the gastrocnemius muscle. The gastrocnemius is a calf muscle responsible for plantar flexion (pointing your toes) and is used in most full body human movements (like walking, running, hiking, biking and even swimming). 

The knot (or fascia adhesion) that forms in the outer part of the calf muscle can pull the patella (kneecap) off track, resulting in a bone on bone feeling. This is often when sharp knife-like knee pain occurs (the exact type of knee pain that stopped me from hiking for 6 years and running for 8 years). 

Medial knee pain is often the result of fascial restriction (and even “knots”) in the quad/adductor junction, very often specifically a muscle called the VMO (vastus medialis oblique, a quad muscle that attaches medially at the knee joint). 

Pain under the kneecap can be a result of fascial restriction in the popliteal fascia, where the plantaris muscle attaches, and occasionally can be the result of low quadriceps fascial adhesions. 

What do all of these patterns have in common? 

A pelvic instability scenario where your brain tells your gluteus medius (primary hip stabilizing muscle) to contract neurologically (a brain command) 24/7 to keep your pelvis stable. 

Gluteus medius is a hip complex and glute muscle that is the primary hip stabilizer while walking, lunging, running, hiking, standing…

Gluteus medius internally and externally rotates the hip, flexes and extends the hip and helps in deceleration during the swing phase of gait (walking). Because the gluteus medius can perform SO many opposing functions (it’s unusual that a muscle can flex and extend the hip for example), the possible compensations are numerous. 

Have you ever heard of “lazy glutes”? It means the gluteus medius (or maybe gluteus maximus) has stopped firing on command. 

Why would the gluteus medius stop activating? 

I challenge the name “lazy” here, because it’s actually my theory that the gluteus medius becomes the overworked, exhausted 24/7 workhorse that provides spinal stability when the brain perceives that there’s been a threat to the spine. 

The human spine relies on a stable pelvis, like a tree relies on its roots in order to stand tall and free. If you cut the roots off the tree, it would have a hard time standing upright, no? 

So what destabilizes the human pelvis? 

Most of the time, it’s a result of fascial imbalances in the lower body, particularly the big muscles of the thigh: quads, quad hip flexors, IT Bands, adductors, hamstrings…

We sit, stand, play sports and live life lopsided; we are not always assymetrical, and while this is normal and natural (after all, the human abdomen is built asymmetrical, with a heart on one side, liver on another, etc). 

Ultimately, pelvic instability is detected by the nervous system, which is responsible for relaying information about threats to the brain, which has the power to decide whether the threat is credible and if so, what to do about it. 

What this means for you if you’re experiencing knee pain:

If you have lateral knee pain, the cause could be as simple as fascial restrictions in your calves due to running or hiking and winding up those tissues (our fascial system needs maintenance just like our muscles, bones and cardiovascular system etc). This could occur due to overuse, unhealthy gait patterns and structural alignment. But, it could be as complex as pelvic instability, resulting in stacking compensations (first your gluteus medius, then your IT Band, then your outer calf fascia which all attempt to keep you stable until they can’t compensate anymore). 

If you have medial knee pain, it could be a sign of overusing your adductors, or it could be because your adductors are “catching” you during walking, running, hiking, working out when you have no gluteus medius activation. 

The popliteal fascia on the back of your knee can kick in to stabilize you when your brain detects that your gluteus medius isn’t activating…leading to overuse restriction and knee pain. 

The telltale sign that you’re in some kind of hip or pelvic instability scenario (including glute inhibition) is when your pain is only one ONE side (left or right sided knee pain, instead of bilateral). 

It is entirely possible that both hips are destabilized, but it’s more a common occurrence on one side only. 

You can get acute relief by releasing key areas of fascia (calves, adductors, VMO, back of knee etc). But if you’re in pelvic instability, in order to eliminate the pain you have to address the root cause and create pelvic and hip stability. This often means getting your glutes firing again through activation exercises and strengthening your posterior chain. 

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